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Randomised controlled trial of health assessments for older Australian veterans and war widows

Julie E Byles, Meredith Tavener, Nick H Higginbotham, Lyn Francis, John E Marley, Rachel L O’Connell, Balakrishnan R Nair, Brendan G Goodger, Claire L Jackson, Mary E McKernon, Richard F Heller and Jonathan Newbury
Med J Aust 2004; 181 (4): 186-190.

Summary

Objective: To assess the effect of home-based health assessments for older Australians on health-related quality of life, hospital and nursing home admissions, and death.

Design: Randomised controlled trial of the effect of health assessments over 3 years.

Participants and setting: 1569 community-living veterans and war widows receiving full benefits from the Department of Veterans’ Affairs and aged 70 years or over were randomly selected in 1997 from 10 regions of New South Wales and Queensland and randomly allocated to receive either usual care (n = 627) or health assessments (n = 942).

Intervention: Annual or 6-monthly home-based health assessments by health professionals, with telephone follow-up, and written report to a nominated general practitioner.

Main outcome measures: Differences in health-related quality of life, admission to hospital and nursing home, and death over 3 years of follow-up.

Results: 3-year follow-up interviews were conducted for 1031 participants. Intervention-group participants who remained in the study reported higher quality of life than control-group participants (difference in Physical Component Summary score, 0.90; 95% CI, 0.05–1.76; difference in Mental Component Summary score, 1.36; 95% CI, 0.40–2.32). There was no significant difference in the probability of hospital admission or death between intervention and control groups over the study period. Significantly more participants in the intervention group were admitted to nursing homes compared with the control group (30 v 7; P < 0.01).

Conclusions: Health assessments for older people may have small positive effects on quality of life for those who remain resident in the community, but do not prevent deaths. Assessments may increase the probability of nursing-home placement.

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  • Julie E Byles1
  • Meredith Tavener2
  • Nick H Higginbotham3
  • Lyn Francis4
  • John E Marley5
  • Rachel L O’Connell6
  • Balakrishnan R Nair7
  • Brendan G Goodger8
  • Claire L Jackson9
  • Mary E McKernon10
  • Richard F Heller11
  • Jonathan Newbury12

  • 1 Faculty of Health, University of Newcastle, Newcastle, NSW.
  • 2 Hunter Area Health Service and John Hunter Hospital, Newcastle, NSW.
  • 3 NHMRC Clinical Tr ials Centre, University of Sydney, Sydney, NSW.
  • 4 Mater Centre for Integrated Health Care and General Practice, University of Queensland, Brisbane, QLD.
  • 5 School of Epidemiology and Health Sciences, University of Manchester, Manchester, UK.
  • 6 Department of General Practice, Adelaide University, Adelaide, SA.

Correspondence: 

Acknowledgements: 

The Preventive Care Trial was initiated and funded by the Australian Department of Veterans’ Affairs. We thank Professor John McCallum, scientific advisor for the study. We also thank Associate Professor Cate D’Este, Dr Patrick Fitzgerald and Associate Professor Lynette Lim for statistical advice; and Dr Lynette Mackenzie for developing the HOME FAST tool used in the home-visit checklist.

Competing interests:

None identified.

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